Abstract
Background
A prominent mandibular angle is a common reason for aesthetic treatment among Asian women. Such women usually present with hypertrophic masseteric muscles, and one treatment for this uses botulinum toxin A (BoNTA). Detailed effectiveness and physiologic influences of this therapy are still under investigation.
Methods
The authors report a prospective study of 10 female volunteers with hypertrophic masseteric muscles who received a single treatment comprising intramuscular injection of BoNTA. The facial change and the discomfort of the injection were self-rated using a visual analog scale, and the patients were regularly inspected up to 1 year. Bite forces also were measured for chronological documentation. Volume changes of masticating muscles were evaluated by three-dimensional computed tomography (CT) scans before and 3 months after injection of BoNTA.
Results
The serial photographs and patient subjective evaluation showed an obvious facial change 3 to 6 months after injection. Bite forces decreased from the first day after injection, but started to recover during week 3 and were normal 3 months after injection. Three-dimensional CT evaluation showed a statistically significant mean masseter reduction of about 30%, but no change in the volume of other masticating muscles. There were no serious complications during this study.
Conclusions
Injection of BoNTA is an effective alternative for contouring of the lower facial profile by reducing the bulkiness of masseteric muscles. Its effectiveness was noticed as early as 2 weeks after injection and reached a peak effect in month 3. The facial contour gradually returned 6 months after injection. The reduction in bite force was temporary and caused no daily life interference.
Similar content being viewed by others
References
Adams WM (1949) Bilateral hypertrophy of the masseter muscle: An operation for correction. Br J Plast Surg 2:78–81
Anonymous (1992) Botulinum toxin. Lancet 340:1508–1509
Baek SM, Baek RM, Shin MS (1994) Refinement in aesthetic contouring of prominent mandibular angle. Aesth Plast Surg 18:283–289
Baek SM, Kim SS, Bindiger A (1989) The prominent mandibular angle: Preoperative management, operative technique, and results in 42 patients. Plast Reconstr Surg 83:272–280
Beckers HL (1977) Masseteric muscle hypertrophy and its intraoral surgical correction. J Maxillofac Surg 5:28–35
Choe SW, Cho WI, Lee CK, Seo SJ (2005) Effects of botulinum toxin type A on contouring of the lower face. Dermatol Surg 31:502–507
Converse JM (1951) Masseter muscle hypertrophy. Unpublished case
Deguchi M, Iio Y, Kobayashi K, Shirakabe T (1997) Angle-splitting ostectomy for reducing the width of the lower face. Plast Reconstr Surg 99:1831–1839
Dewandre L, Voloshchenko I, Trembach A (2003) Pilot study to compare the efficacy and the duration of activity of Dysport vs Botox in classical aesthetic indications (forehead, glabella, crow’s feet). J Med Esth Et Chir Derm 30:101–107
Gurney CE (1947) Chronic bilateral benign hypertrophy of the masseter muscle. Am J Surg 73:137–139
Hambleton P, Pickett AM (1994) Potency equivalence of botulinum toxin preparations. J R Soc of Med 87:719
Jankovic J, Brin M (1991) Therapeutic uses of botulinum toxin. N Engl J Med 324:1186–1194
Kim HJ, Yum KW, Lee SS, et al (2003) Effects of botulinum toxin A on bilateral masseteric hypertrophy evaluated with computed tomographic measurement. Dermatol Surg 29:484–489
Kim NH, Chung JH, Park RH, et al (2005) The use of botulinum toxin A in aesthetic mandibular contouring. Plast Reconstr Surg 115:919–930
Kim SK, Han JJ, Kim JT (2001) Classification and treatment of prominent mandibular angle. Aesth Plast Surg 25:382–387
Moore AP, Wood GD (1994) The medical management of masseteric hypertrophy with botulinum toxin type A. Br J Oral Maxillofac Surg 32:26–28
Niamtu J III (1999) Aesthetic uses of botulinum toxin A. J Oral Maxillofac Surg 57:1228–1233
Park MY, Ahn KY, Jung DS (2003) Botulinum toxin type A treatment for contouring of the lower face. Dermatol Surg 29:477–483
Pathak MS, Nguyen HT, Graham HK, Moore AP (2006) Management of spasticity in adults: Practical application of botulinum toxin. Eur J Neurol 13(Suppl 1):42–50
Pickett AM, Hambleton P (1994) Dose standardization of botulinum toxin. Lancet 344:474–475
Robb RA (1999) Biomedical imaging: Visualization and analysis. John Wiley and Sons, Inc.: New York
Robb RA, Hanson DP, Karwoski RA, Larson AG, Workman EL, Stacy MC (1989) Analyze: A comprehensive, operator-interactive software package for multidimensional medical image display and analysis. Comput Med Imaging Graph 13:433–454
Satoh K (1998) Mandibular contouring surgery by angular contouring combined with genioplasty in orientals. Plast Reconstr Surg 101:461–472
Smyth AG (1994) Botulinum toxin treatment of bilateral masseteric hypertrophy. Br J Oral Maxillofac Surg 32:29–33
To EW, Ahuja AT, Ho WS, King WW, Wong WK, Pang PC, Hui AC (2001) A prospective study of the effect of botulinum toxin A on masseteric muscle hypertrophy with ultrasonographic and electromyographic measurement. Br J Plast Surg 54:197–200
von Lindern JJ, Niederhagen B, Appel T, Berge S, Reich RH (2001) Type A botulinum toxin for the treatment of hypertrophy of the masseter and temporal muscles: An alternative treatment. Plast Reconstr Surg 107:327–332
Acknowledgments
The authors especially thank Ms. Mon-Jen Wu for processing of 3D CT images, and Ms. Hsiao-Wha Lee for managing the follow-up evaluation of the patients.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yu, CC., Chen, P.KT. & Chen, YR. Botulinum Toxin A for Lower Facial Contouring: A Prospective Study. Aesth Plast Surg 31, 445–451 (2007). https://doi.org/10.1007/s00266-007-0081-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-007-0081-8